Neurosurgeons’ Critical Role in Managing Traumatic Brain Injury

To the Editor We read with interest the study by Joseph et al.¹ Their Brain Injury Guidelines (BIG) protocol is a local hospital protocol that endeavors to define criteria for the imaging, admission, and management of patients with traumatic brain injury (TBI). The BIG protocol was devised at a level I trauma center with the input of the neurosurgery department, but no neurosurgeon was included on the author panel. In contrast, the American College of Surgeons Trauma Quality Improvement Program recently introduced a best practice document in TBI management, authored cooperatively by neurosurgeons, led by Geoffrey Manley, MD, PhD, and trauma surgeons, among others.² We assert that all such projects should include neurosurgeons.